In the following, we find the clues to why everything is totally screwed up; we also find the justification that has been drilled into doctors for why they are doing what they are doing.
wattsupwiththat.com
This letter from our local hospital ER doc has been circulating on social media in my town. It is applicable for anyone, anywhere, to read and heed. Note “the surge” section – Anthony
A frank open letter from an emergency room doctor on #COVID-19 – The “surge” is coming
This letter from our local hospital ER doc has been circulating on social media in my town. It is applicable for anyone, anywhere, to read and heed. Note “the surge” section – Ant…
wattsupwiththat.com
This letter from our local hospital ER doc has been circulating on social media in my town. It is applicable for anyone, anywhere, to read and heed. Note “the surge” section – Anthony
https://www.enloe.org/find-a-doctor/find-a-doctor?id=232Dear Butte County and all the folks who may under the care of Enloe Medical Center,
I am one of your local Emergency Medicine docs at Enloe Medical Center. So I’d like to take a moment to explain Covid-19 and how and why it is impacting our community.
Specifically, I’d like to go through the basics of the illness and (as a consequence) what Enloe Hospital is doing to meet the coming crisis.The first thing I will mention is that the Covid-19 disaster is an extremely dynamic and changing situation.
Every day at the hospital we are meeting constantly and changing policies–directions from world, federal, and state programs change multiple times per day. This is an unheard of pace of change.Here are the basics about the Covid-19 illness. The virus is highly contagious. It is predicted that eventually, nearly everyone will be exposed and been infected.
A very few very lucky people may not develop any symptoms at all. The vast majority of people will get a mild syndrome of variable symptoms including “flu”–fevers, achy-ness, upper respiratory congestion (ie nose and throat symptoms). Then they will get over it. And probably wonder what the big fuss about it was. Younger children may have an even milder syndrome.
However, during the typical 7 days of mild disease and then another 7 days later, all infected patients will be spreading this virus. If you turn up to the Emergency Department with mild illness, you will be screened (important factors such as vital signs and your oxygen saturation percentage), and likely sent home with 2 important instructions: signs of worsening illness, and strict self-quarantining precautions.
However, if you are unlucky, after the initial mild syndrome, instead of getting better, you may get worse. You may develop worse “flu” symptoms and then pneumonia–filling of the lungs with infected fluid.
These are the patients that will be admitted to the hospital for general care and observation. Once again, the majority of these moderately ill patients will get better.
However, if you are very unlucky, over the next day or two, instead of getting better, some patients will turn for the worse and will develop a form of ARDS (Acute Respiratory Distress Syndrome) whereby the lungs will become completely saturated with fluid and will need to be placed on “life-support”, that is a mechanical ventilator. They will be transferred to the ICU (Intensive Care Unit) until their lungs can recover.
A large proportion of these patients will eventually recover, but some will not. There are some clear risk factors for ending up in the ICU. Older age and baseline medical illness (diabetes, chronic heart disease, chronic lung disease) make it much more likely to go on to ICU-requiring Covid-19 illness. However, even perfectly healthy adults can develop serious illness. Fortunately, younger children are almost entirely spared.The overall picture of this sort of illness is NOT new to the medical community. Most of what I have described above (mild/moderate/ICU levels of illness) can be applied to the Influenza virus, which we have been dealing with for years.
The concerning difference is the infectivity of the Covid-19 virus, and mathematics. Using some basic simplified statistics will yield math that is causing everyone in the hospital to enact drastic measures.
Enloe Medical Center covers roughly 300,000 people in Butte and surrounding counties. As I mentioned everyone will get Covid-19. If only 0.5% of patients who get Covid end up in the ICU, that will be 1,500 patients requiring an ICU. Prior to our Covid planning, Enloe had only 20 ICU beds. 1,500 patients will not safely squeeze into 20 beds. This, my friends, is the SURGE. This was what overwhelmed the hospital systems in China and Italy.
Make no mistake the surge is coming.
So pretty much everything we are doing- all this “social distancing”- is to even out this massive surge of patients and spread them out over time, as opposed to having all of them show up at our hospital at once. And the analysis of China and Italy has produced a clear message. The most effective strategy to mitigate the surge is strict quarantining. Not disease testing. Not experimental medications or specific treatments. Quarantining, social distancing, whatever it takes to slow (not stop, not cure) the spread of disease.
So take quarantining and social distancing seriously, because it will save lives.
And it may be hard to take seriously, because as I mentioned the vast majority of people will only get mild illness. And then they may ask themselves, why did I go through so much trouble, not being able to go to my favorite bar.
Even more seriously, the economy is heading downhill and many people are not getting paychecks. For a mild “flu”. Again, the answer is that all of the sacrifices are NOT for the mildly ill, but for the unlucky ICU bound. And that may be you or your loved one. Picture this:
Scenario One–your loved one is developing ICU level pneumonia. The team of doctors, nurses, and care-givers identify this, treat your loved one and move her to the ICU.
Scenario Two–your loved one is developing ICU level pneumonia. But there is no room in the ICU and she is put on a jury-rigged breathing contraption for life support in the hallway outside of the Emergency Department. Next to 60 other patients in the same situation.
And the message from China and Italy and other countries has been specific–the most effective strategy to avoid Scenario 2 is aggressive quarantining of the mildly ill and EVEN asymptomatic. Employing strong individual efforts to prevent contracting Covid-19 will slow the progression and buy time to smooth the ICU surge– and it may also buy time for doctors and scientists to develop and test treatments and vaccinations.Some common questions that I have been asked–Why can’t I be tested for Covid?
Every day, the hospital is attempting to obtain methods for rapid testing of Covid, but as you might imagine the supply of testing materials is a lot more rare and much more expensive than toilet paper. Another common question is: Does it seem that the hospital is over-reacting? The answer is “We hope so!”
And–don’t forget that hospital workers are at highest risk for exposure and spreading the illness. Which is why we are trying to be so meticulous about infection prevention–don’t be surprised if you end up in the Emergency Department, respiratory issues or other standard ER problems, staff are wearing gowns, masks, and greeting you from a distance. If a hospital worker starts to show symptoms of infection, this will remove him or her from a very limited working pool for a long period of time. And we need every hospital worker we have.
{Is that why some hospitals are closing down and sending staff home or firing them?}
Another comment I would like to make: If you have an elderly family member or loved one with advanced illness, please take the time to appreciate them. And then discuss the possibility that they might develop severe Covid-19 illness. No decision at this time has to be final, but it is better to understand where everyone stands prior to the storm hitting.
Here is another question: When? This is a tricky one, because we do not locally have quick testing for Covid-19. The current wait time to get a test result back is over 1 week. Our first official Covid positive test in Butte County was on Saturday March 21. As of today (Mar 25) there are at least 4 documented positive cases in Butte County, though likely there are many more people who are infected but have not been tested, due to the shortage of testing kits and assays. So people in our community are right now progressing through the contagious but mild symptom stages. We anticipate pneumonia and ICU patients declaring themselves within the next few weeks.
Thank you for reading, and thank you for keeping Chico safer,
Ivan Liang
Ivan Liang,
MD FACEP FACMT
Ivan E. Liang, MD
Last edited:
